Stock Management in Whotopia

Whotopia Ministry of Health staff visited clinics to document existing stock management workflows. The most common workflow is as follows:

1. Medical personnel enters the medical store and requests a certain amount of one or more commodities from the store manager. The request is always in the number of packs - not singular quantities of the commodity. For instance, medical staff may request seven packs of “Misoprostol”, and two packs of “Magnesium Sulfate”, but never one tablet of “Misoprostol”. 
2. The store manager checks the stock balance of the requested stocks on a paper-based “stock-balance” form which includes the balance of all available commodities (Figure 2).
   
   
   Figure 2: Stock Balance Sheet
3. If the stock balance is too low for one or more of the requested commodities, the store manager negotiates with the medical personnel to agree on a reasonable number of commodities. The store manager should take into consideration how much stock is left, and how long it is until the next delivery of commodities (commodities are delivered to clinics on the 14th of every month). For example, if the medical personnel requests twenty packs of Misoprostol, the current stock balance is eighteen, and it is two weeks to the next shipment delivery date, the store manager will suggest a much lower number to be dispensed than if a new shipment were to arrive in a couple of days.  
4. The store manager collects the requested stocks from the shelves and gives these to the medical personnel.
5. The store manager registers the transaction in a paper-based “transaction” registry (Figure 3), including a) the date and time, b) what commodities and the number dispensed c) the name of the store manager dispensing the commodity, and d) the name and department of the medical personnel receiving the commodities. 
   
   
   Figure 3: Commodity dispensing registry
6. The hospital store manager calculates the updated stock balance and updates the paper-based “stock-balance” form (Figure 2).

Consumption reporting and ordering of commodities
Every month, the store manager fills out and submits the consumption and order form (Figure 1), based on the numbers registered in the “stock-balance” forms filled out during the month. 

When a shipment of new commodities arrives
The store manager must update the “stock-balance” form (Figure 2) by adding the number of received stocks to the existing stock balance for each stock.  

Dealing with stock-outs
The clinics in Whotopia only get a shipment of commodities on the 14th of every month. When suffering from stock-outs, it is not possible to request commodities besides the standard delivery on the 14th. However, the store managers may attempt to contact the store managers at other clinics to learn if they have surplus stocks. As articulated by a hospital store manager: 

“People may call from nearby clinic if they suffer from stock-outs. Then, I check if we have more than we probably need for the remaining time before the next shipment from the regional warehouse. If that is the case, I send a certain amount of stock to the ones suffering from stock-outs”
 

The primary end-user is the store manager. Store managers are typically educated in pharmacy and logistics and are responsible for the daily operations of the medical stores. However, some acting store managers are currently not meeting the qualification requirements. Some medical stores are managed by staff at the clinic that are not formally trained pharmacists nor logistics experts. At some clinics it has been difficult to recruit qualified staff, while at others there is not sufficient funding to employ a dedicated store manager. 

Their store managers work includes managing the storage of commodities, keeping track of stocks, stock-outs, dispensing of commodities, and ordering and receiving shipments of stocks from the regional warehouses.

A recent assessment carried out by the Ministry of Health found problems of missing data, incorrect data, arithmetical errors, and duplicate data. The general lack of on the job training appears to have a negative impact on store managers understanding of the data collection tools and data quality issues.

There are significant differences in the digital literacy levels of the store managers. Some have extensive experience with the use of statistical software and use smartphones and tablets as part of their daily life. Others have limited experience with the use of digital technologies and are more accustomed to paper-based information systems. 

 “What is important for me is that I can run a well-organized medical store and be able to provide commodities efficiently. This means that it is important for me to keep a good and systematic overview of the current stock balances, and past transactions. Sometimes, we are subject to a review from the Ministry of Health, which means that I must be able to quickly offer statistics of my current stock balances” - Store manager at a clinic in Whotopia

Beyond the fundamental requirements, you should address at least two of the additional requirements described below. The minimum requirements described for each is what must be implemented. Consider carefully which requirements goes well together and would comprise a useful and coherent whole. When in doubt about the use context of the application, please record the assumptions you make in order to arrive at application design and development decisions.

1. Store management

Every month, the store manager receives a new delivery of commodities to replenish the medical store. The store manager needs to efficiently update the stock balance according to the exact quantities received of each commodity, and this information must be recorded.

Minimum requirements:

• develop an interface that supports efficiently updating stock balances when dozens of different commodities are received at the medical store
• the data set “Life-Saving Commodities” should be updated, and a stock replenishment “transaction” should be recorded

2. Stock level monitoring / prediction

It is important for the store manager to ensure that stocks last through to the 14th every month. Currently, this is done based on the store managers' personal experience with how much of each commodity is typically dispensed, and the stock balance at any given time. With a digital stock management application, data is available to provide some decision support to the store manager. For example, it is possible to look at the quantities and the frequencies of dispenses in previous periods, stock balance trends, days until next replenishment (14th of the month), etc.

Minimum requirements:

• Provide the store manager with decision support functionality that helps assess how much of a commodity can be dispensed at a particular time without high likelihood of stock-outs

3. Requests commodities from nearby clinics (other orgunits)

When a clinic is critically low on stock, they may request an urgent transfer of commodities from nearby clinics. Nearby clinics are other clinics within the same health district and they will are share the same "parent" organization unit. Since all clinics interact with the same database, it is possible to assess the current stock balance of nearby clinics, so that store manager knows from where they might request a transfer.

Minimum requirements: 

• provide store managers with an overview of available stocks in nearby clinics, to help identify where there is potential for receiving a transfer

4. Improved management of commodity recipients

Entering the name and department of the medical personnel to which commodities are dispensed as free text can be inefficient, and makes later analysis of the data difficult. Because medical personnel are often in a hurry, it is important that new registrations of commodity recipients do not introduce unnecessary delays.

Minimum requirements:

• develop a solution that allows medical personnel and hospital departments to be stored/persisted in the database, to be used as “recipients” during commodity dispensing
• the functionality to persist names/departments should be integrated in the function to register when a commodity is dispensed (see fundamental requirement)

5. Stock recounts

At regular intervals, the store managers need to perform recounts of the actual stock at hand, to verify that the stock balance in DHIS2 (“Life-Saving commodities”) corresponds to the physical stock in the medical store. This involved the store manager physically counting the number of packs/items of each commodity in the store, one by one, and updating the “stock balance sheet” (figure 2). Since the recounts are only documented as updates in the stock balance form, it is difficult to analyze the data, for example to identify if certain commodities tend to systematically disappear from the store.

Minimum requirements: 

• develop a solution tailored for a physical stock recount workflow
• the data set “Life-Saving Commodities” should be updated, and a stock recount “transaction” should be recorded for discrepancies

6. Sandbox mode

As the store managers profiles vary in terms of experience and digital literacy, the Ministry of Health would like the application to have a "sandbox" or training mode where the user can test the flow of the application and get more tips and guidance on how to use the application. Any changes to stock balances etc. made in the sandbox mode should not be stored permanently.

Minimum requirements: 

• develop a sandbox mode that allows the user to test and experience the main workflows of the application and receive additional tips and guidance
• include user feedback that is beneficial for novice users but not deemed necessary for the day-to-day use of the application

7. Offline features (warning: can be relatively challenging to implement)

The stock management application will be used in a setting with intermittent internet connectivity. The Ministry of Health wants the application to support offline workflows in periods where internet connectivity is lost so that stock management work can continue to be carried out and data can be synchronized when internet connectivity is restored.

Minimum requirements: 

• develop offline support for essential stock management workflows (see fundamental requirements) while making sure data integrity is not compromised

8. Analytics dashboard

Sometimes, in order to discover trends and patterns in commodity consumption or discrepancies in effective stock management, it is useful to look at statistics in the form of graphs, tables, charts or maps. An analytical summary can also be useful in the case of a sudden inspection conducted by the central unit at the Ministry of Health.

Minimum requirements: 

• develop an analytics dashboard with visualization of relevant indicators pertaining to the stock management at the clinic. You should at the very least find good ways to represent the information mentioned as relevant in the case of a review / inspection.

9. Manage bulk operations

As most medical personnel require dispensing of more than one commodity at the same time, it is necessary to support a workflow where multiple commodities can be selected for dispensing, verified, and registered in one bulk operation. 

Minimum requirements: 

• develop support for bulk operations to verify and dispense multiple commodities